Cardiocenter, Department of Cardiology, 3rd Medical School, Charles University and University Hospital Kralovske Vinohrady Prague, Srobarova 50, Prague, Czech Republic.
Europace. 2013 Jul;15(7):963-9. doi: 10.1093/europace/eus432. Epub 2013 Feb 27.
The indications for implantable cardioverter-defibrillators (ICDs) have been expanding, especially for primary prevention of sudden cardiac death. Implantable cardioverter-defibrillator saves lives; however, in near end-of-life situations linked to incurable diseases, the question arises as to whether or not to turn off the ICD to avoid excessive numbers of shocks as the heart begins to fail. This study examined the wishes of a cohort of ICD recipients.
Consecutive recipients of ICDs for primary or secondary prevention of sudden cardiac death were examined during a routine out-patient follow-up visit. Subjects completed a written survey about expected ICD benefits, feelings and circumstances under which they would want to deactivate the device. One hundred and nine patients fully completed the survey. Mean age was 67.6 ± 8.7 years, 91 (83.5%) were male and the mean systolic ejection fraction was 31.5 ± 10.9%. The severity of symptoms of heart failure according to the New York Heart Association classification was 2.1 ± 0.59 at implantation. Ninety-nine (90.8%) patients felt more secure and safe following ICD implantation and 66 (60.6%) patients reported a sense of improved health status after implantation. Thirty-one (28.4%) patients had experienced an ICD shock. Fifty (45.9%) patients indicated that they had never considered ICD deactivation during near end-of-life situations. This topic had been discussed with only eight (7.3%) patients. Forty-four (40.1%) patients wanted more information about ICD deactivation. On the other hand, 10 (41.7%) patients from secondary prevention and 19 (22.4%) from primary prevention groups categorically refused more information or further discussion on this topic (P = 0.058).
Most ICD recipients felt safer following ICD implantation and most wanted more information regarding ICD deactivation. However, a significant number of patients (especially, secondary prevention patients) had no interest in receiving additional information about this topic.
植入式心脏复律除颤器（ICD）的适应证一直在扩大，特别是用于预防心源性猝死的一级预防。植入式心脏复律除颤器可以拯救生命；然而，在接近生命末期的情况下，与无法治愈的疾病相关，就会出现是否关闭 ICD 以避免随着心脏衰竭而过度电击的问题。本研究检查了一组 ICD 接受者的意愿。
在常规门诊随访期间，对因一级或二级预防心源性猝死而接受 ICD 的连续接受者进行了检查。受试者完成了一份书面调查，内容涉及对 ICD 预期获益的感受，以及他们希望停用该设备的情况。109 名患者完整地完成了调查。平均年龄为 67.6±8.7 岁，91 名（83.5%）为男性，平均收缩射血分数为 31.5±10.9%。根据纽约心脏协会（New York Heart Association）分类，植入时心力衰竭症状的严重程度为 2.1±0.59。99（90.8%）名患者在植入 ICD 后感到更安全和放心，66（60.6%）名患者报告植入后健康状况有所改善。31 名（28.4%）患者经历过 ICD 电击。50 名（45.9%）患者表示，在接近生命末期的情况下，他们从未考虑过 ICD 停用。只有 8 名（7.3%）患者讨论过这个话题。44 名（40.1%）患者希望获得更多关于 ICD 停用的信息。另一方面，10 名（41.7%）来自二级预防组和 19 名（22.4%）来自一级预防组的患者断然拒绝获得更多关于这个话题的信息或进一步讨论（P=0.058）。
大多数 ICD 接受者在植入 ICD 后感到更安全，大多数人希望获得更多关于 ICD 停用的信息。然而，相当数量的患者（特别是二级预防患者）对获得有关该主题的更多信息不感兴趣。
